PPO Select Value® CareSM
General Benefits
| In-Network Benefits | Out-Of-Network Benefits |
| PPO Select Value Care pays 50% and you pay 50% of eligible expenses | PPO Select Value Care pays 50% and you pay 50% of eligible expenses |
|
Physician office visits paid at 50/50 coinsurance. |
Physician office visits paid at 50/50 coinsurance. |
| Network providers will preauthorize your medical care. | You must preauthorize hospital admissions and certain services. |
| No claim forms to file | You may have to submit claims for reimbursement |
| Emergency room visits within 48 hours of accident paid at 50/50 coinsurance. | Emergency room visit within 48 hours of accident paid at 50/50 coinsurance. |
